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~. <br />• ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Camp Bird Colorado, Inc. <br />M-1982-090 <br />Camp Bird Mine <br />December 7, 1999 <br />$550.00 (Due on or before your anniversary date) <br />Ouray <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are amicipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report moo to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the nbove elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Scott A. Butters <br />Permittee Name: Camp Bird Colorado, Inc. <br />Address: P.O. Box 806 <br />Salt Lake Ciry, l17' 84110 <br />Phone Number: (303) 325776 <br />Fax Number: (801) 521-6400 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />• Date <br />